Youth Townhall Student Registration

Game Changers: Celebrating & Learning from Black Youth Leadership

America’s Promise Alliance invites you to participate in the Game Changers Roundtable on Friday, February 26, 2021 1:00 – 2:30 PM ET to join the conversation with Black youth and adult leaders to explore how we can share power and work across generations to write the next chapter of progress for the United States. 

Please note that this is the registration page for middle and high school students. If you are a school leader or other youth-supporting adult, please register here: https://americaspromise.zoom.us/webinar/register/WN_UfnXFNirT2-afFJOa05cJQ

Questions: If you have any questions, please contact America’s Promise at digital@americaspromise.org.
Are you 18 years or older?*

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Name*

First NameLast Name
Email*
example@example.com
What grade in school?*
Where are you joining us from?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What is your date of birth?*

MonthDayYear
Date
Media Release Agreement:

America's Promise Alliance (www.americaspromise.org), their subsidiaries, successors and assigns, irrevocable, unqualified, transferable, royalty-free, my permission to use my likeness, photograph, video and biographical data related to the event and on APA’s website, a website of an affiliate, or otherwise, reformat, adapt, translate, display, excerpt in whole or in part, and distribute in any form, medium or technology, my video or photograph for any purpose on or in connection with APA’s website, business, or the promotion thereof without payment or any other compensation. I understand and agree that these videos and photographs are the property of America's Promise Alliance.
In addition, I waive the right to inspect or approve the finished product, including written/physical or electronic copy, wherein my likeness appears. I also waive the right to royalties or other considerations arising or related to the use of these materials. I agree to release, indemnify, and hold harmless APA and their officers, directors, members, employees, and agents, from and against any and all claims, actions, losses, demands, costs, attorneys’ fees, and all other expenses relating or incidental to or arising directly or indirectly from (i) APA’s use of the Licensed Materials, including, without limitation, all claims for invasion of privacy, infringement of my publicity, celebrity, personality, or any other similar matter, defamation, and any other personal and/or property rights; and (ii) the inaccuracy or breach of any of the aforementioned warranties and representations.
America's Promise Alliance is a nonprofit organizations which does not profit or gain any commercial compensation for our video and web content.
I am at least 18 years old and have read this Agreement, fully understand and agree to its terms, and understand that I am giving up substantial rights by consenting. I am consenting to these terms freely and voluntarily, without any inducement or coercion.*

I consent
Youth Signature

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Your Name

First NameLast Name
Email*
example@example.com
What grade (in school) will you be entering this fall?*
Where are you joining us from?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What is your date of birth?*

MonthDayYear
Date
Parent or Guardian's Name

First NameLast Name
Parent or Guardian's Email
example@example.com
Media Release Agreement:

America's Promise Alliance (www.americaspromise.org), their subsidiaries, successors and assigns, irrevocable, unqualified, transferable, royalty-free, my permission to use my likeness, photograph, video and biographical data related to the event and on APA’s website, a website of an affiliate, or otherwise, reformat, adapt, translate, display, excerpt in whole or in part, and distribute in any form, medium or technology, my video or photograph for any purpose on or in connection with APA’s website, business, or the promotion thereof without payment or any other compensation. I understand and agree that these videos and photographs are the property of America's Promise Alliance.
In addition, I waive the right to inspect or approve the finished product, including written/physical or electronic copy, wherein my likeness appears. I also waive the right to royalties or other considerations arising or related to the use of these materials. I agree to release, indemnify, and hold harmless APA and their officers, directors, members, employees, and agents, from and against any and all claims, actions, losses, demands, costs, attorneys’ fees, and all other expenses relating or incidental to or arising directly or indirectly from (i) APA’s use of the Licensed Materials, including, without limitation, all claims for invasion of privacy, infringement of my publicity, celebrity, personality, or any other similar matter, defamation, and any other personal and/or property rights; and (ii) the inaccuracy or breach of any of the aforementioned warranties and representations.
America's Promise Alliance is a nonprofit organizations which does not profit or gain any commercial compensation for our video and web content.
I am the parent or legal guardian of the Participant and have read this Agreement, fully understand and agree to its terms, and understand that I am giving up substantial rights by signing it. I sign this Agreement freely and voluntarily, without any inducement or coercion.*

I consent
Parent or Guardian's Signature

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Media Release Agreement:

Media Release Agreement: